The Cigna Group

IFP Quality Review and Audit Analyst

The Cigna Group

full-time

Posted on:

Location Type: Remote

Location: Remote • 🇺🇸 United States

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Salary

💰 $25 - $38 per hour

Job Level

JuniorMid-Level

About the role

  • Conduct medical records reviews with accurate diagnosis code abstraction
  • Utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC)
  • Identify all valid data elements and opportunities for data capture
  • Perform documentation and data audits identifying gaps and compliance risks
  • Collaborate with team members and matrix partners to facilitate coding and Risk Adjustment education
  • Communicate effectively across all audiences
  • Develop and implement internal program processes

Requirements

  • High school diploma
  • At least 2 years’ experience in medical documentation audits and medical chart reviews
  • Proficiency with ICD-10-CM coding guidelines and conventions
  • Familiarity with CMS regulations for Risk Adjustment programs
  • Computer competency with excel, MS Word, Adobe Acrobat
  • Detail oriented, self-motivated, excellent organization skills
  • Understanding of medical claims submissions preferred
  • HCC coding experience preferred
Benefits
  • Medical, vision, dental, and well-being and behavioral health programs
  • 401(k) with company match
  • Company paid life insurance
  • Tuition reimbursement
  • Minimum of 18 days of paid time off per year
  • Paid holidays

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills
ICD-10-CM codingmedical documentation auditsmedical chart reviewsdata auditsdiagnosis code abstractionHCC codingdata capture
Soft skills
detail orientedself-motivatedexcellent organization skillseffective communication
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